07-B11-01
APPLICATION FORM
Please contact AGI Education Limited (AGI)’s registered agents or AGI directly for
detailed information regarding the school and its programmes before you complete this
application form.
Pre-application information
For detailed information about AGI programmes, fee schedule, programme duration, facilities, resources,
employment and career pathways, student support and services, accommodation, AGI policies and procedures,
Refund and Withdrawal procedures, Attendance and Disciplinary procedures, Recognition of prior learning or current
competency, NZQA complaint procedures refer to the AGI Programme Learner Handbook. For detailed information
on The Educational Code of Practice (Pastoral care of international students) 2016, life and study in New Zealand
(study, work, clothing, weather, transport, immigration, visa, insurance and accommodation) you may visit one or
all of the following:
AGI registered agents
AGI website: www.agi.ac.nz
Study in New Zealand: www.studyinnewzealand.govt.nz
New Zealand now: www.newzealndnow.govt.nz
The Education Code of Practice (Pastoral care for international students) http://www.nzqa.govt.nz/assets/Providersand-partners/Code-of-Practice/tertiary-guidelines-code-of-practice.pdf
Immigration New Zealand: www.immigration.govt.nz
New Zealand Qualifications Authority: www.nzqa.govt.nz
Information about experiences of past students are available on the AGI Facebook page.
If you are applying through an AGI registered agent, you may ask the agent to explain to you (and/or your parents
and/or the legal guardians) all the information in your own language for clear understanding.
It is important to read and understand the pre-application information before filling the application form.
We will process your application only when we receive all the information and documents we need. Please print
clearly in English when filling in this form. Please do not provide a PO Box address.
Please update your personal data to our administration staffs with evidence if your situation changes.
SECTION 1 Applicant’s Personal Details
Title
Gender
Male
Female
Mr Ms Mrs Miss
Other__________
Family Name
First Name (s)
Preferred Name
Passport Number
Date of Birth
(DD/MM/YY)
Expiry Date
Citizenship
Ethnicity
NZ Permanent
Resident
□ YES □ NO
Version: 6 Date: September 2016
NSI number (if any)
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SECTION 2 Applicant’s Contact Details (in home country)
Please, no agent details in this section. This address will be used as your main address for all correspondence unless an AGI
registered agent has been appointed. In case you apply through an AGI registered agent, all correspondence relating to your
application will be forwarded to that agent.
Street number and name
City/Region
Country
Mobile
Suburb/Town
Post Code
Telephone
Email
Applicant’s Contact Details in New Zealand (if applicable)
Street number and name
City/Region
Country
Mobile
Emergency Contact Person
Name
Relationship to you
Suburb/Town
Post Code
Telephone
Email
Telephone
SECTION 3 AGI Registered Agent Details (If you apply through an AGI registered agent)
Name of the agency
Name of the Agent
Email
Place agent stamp here
SECTION 4 Programme Selection (Please refer to programme details on the AGI website and Programme
Learner Handbook for details before selecting the programme of study. Please contact AGI directly for any
programme related query).
No.
Programme Name
1.
2.
3.
4.
5.
6.
7.
Certificate in English for Academic Purpose and IELTS
English Language Training Course
Diploma in Healthcare Studies (Level 5)
Diploma in Healthcare Management (Level 6)
Diploma in Health (Advanced) (Applied Management) (Level 7)
Diploma in Health Services Management (Level 7)
New Zealand Diploma in Information Systems (Level 5)
Version: 6 Date: September 2016
Total
teaching
weeks
variant
variant
39
36
40
40
40
Tick the
box







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8.
9.
10.
11.
New Zealand Diploma in Information Technology Technical Support (Level 5)
40
New Zealand Diploma in Information Systems - Business Analysis (Level 6)
40
New Zealand Diploma in Information Systems - User Experience (Level 6)
40
New Zealand Diploma in Systems Administration - Cloud and Virtualisation
40
(Level 6)
Note: In addition to the teaching week there will also be a semester/summer break of 2-4 weeks.
07-B11-01
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

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Programme start date 
Programme end date 
Refer to the AGI Programme Learner Handbook for programme descriptions and the entry requirements for each
programme and contact us for additional information. Please select the Programme based on your existing skills,
current education, future career aspirations and education pathways.
In the event of insufficient student enrolments, staff resource and / or other matters, AGI reserves the right to explain,
change or cancel the programme intake and fees without prior notice.
SECTION 5 Entry Requirements
English Proficiency
If English is not your first language you will need to have completed one or more of the following tests within the
last two years: IELTS (academic), TOEFL, NZCE or AGI Internal Entry Requirement Test*. Please refer to entry
requirements as per Programme Learner Handbook for more details on English proficiency requirements.
*Conditions apply
What is your first language? ___________________
If English is not your first language, please tick one of the following boxes that applies to you
 I have completed an English language test
 I will provide my English language test result at a later date
 English was the medium of instruction of my previous years of study. I have attached documentary evidence.
Note: In case of failure to satisfy the English language criteria listed above, your enrolment will be terminated.
Academic Backgrounds
Certified documentation of academic results for your qualification/s must be provided. Please note that you may also
be required to attend an interview.
Qualification 1
Name of School / University
Country
Qualification
Year Start
Year Finish
Qualification 2
Name of School / University
Country
Qualification
Year Start
Year Finish
Version: 6 Date: September 2016
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SECTION 6 Accommodation Details
AGI use accommodation agents to organise and monitor student accommodation following Outcome 6 to the Code
of Practice for the Pastoral Care of International Students.
Do you require AGI to arrange your accommodation:
 YES  NO
(If yes please complete the Accommodation Application Form)
For detailed information on accommodation please refer to the Programme Learner Handbook.
SECTION 7 Insurance
Do you have a Medical and travel Insurance to cover the period of the study?
If yes, please attach a copy of policy.
If no, do you require AGI to arrange Medical and travel Insurance for you?
 YES  NO
 YES  NO
International students must hold acceptable insurance from the time of their enrolment until their visa expiry (or
departure from New Zealand). Immigration New Zealand has defined “acceptable insurance” as insurance that is
compliant with the Educational Code of Practice and acceptable to the student’s education provider.
Detailed information about insurance can be found out from
http://www.nzqa.govt.nz/assets/Providers-and-partners/Code-of-Practice/tertiary-guidelines-code-of-practice.pdf
Most international students are not entitled to publicly funded health services while in New Zealand. If you receive
medical treatment during your visit, you may be liable for the full costs of that treatment. Full details on entitlements
to publicly-funded health services are available through the Ministry of Health, and can be viewed on their website
at http://www.health.govt.nz/
The Accident Compensation Corporation provides accident insurance for all New Zealand citizens, residents and
temporary visitors to New Zealand, but you may still be liable for all other medical and related costs. Further
information can be viewed on the ACC website at http://www.acc.co.nz/
SECTION 8 Ensuring full disclosure
Do you have any pre-existing medical conditions?
Do you have any learning needs in order to study the programme you wish to enrol for?
Please note that international students are not eligible for any special needs funding.
 YES  NO
 YES  NO
A student with special needs includes a student who experiences a physical, sensory, cognitive, psychological, or
behavioural difficulty, or a combination of these, and that difficulty or those difficulties affect his or her ability to
participate, learn, and achieve.
Please note that non-disclosure of pre-existing conditions can have an impact on Insurance coverage and may lead to
non-coverage of certain medical treatments. A disclosure does not necessarily mean that student may not be enrolled
in the programme but it helps to know the differences in medication between New Zealand and their home country
before the student arrives.
The student must hold adequate medical and travel insurance throughout his/her period of enrolment and any
extensions. AGI cannot be held responsible for any sickness, injury, death, damage or loss incurred either outside of
the AGI campus or within the AGI campus, clinical placement, or on AGI activities / tours outside campus.
AGI shall not be liable if the services offered cannot be provided for reasons beyond AGI’s control.
Version: 6 Date: September 2016
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07-B11-01
Privacy Act 1993
Personal information collected on this form and other documents submitted to support this application may be
disclosed to academic and administration staff where relevant to their duties, and also where relevant to other agencies
such as the Ministry of Education, Tertiary Education Commission, New Zealand Qualifications Authority,
Immigration New Zealand, and providers of work experience for students in programmes with a practical component.
In addition, when required by law, AGI will release information to government agencies such as the New Zealand
Police, Department of Justice, Inland Revenue, Ministry of Social Development and the Accident Compensation
Corporation.
You have the right to access and correct personal information about you which has been collected by AGI.
SECTION 9 Statement of Purpose for studying this programme
Kindly provide a statement of purpose along with this application on outlining your interest, future career intensions,
further study plans (if any) and how studying this programme may help you build a successful career. (If required,
please continue on an extra sheet of paper and attach it to this application).
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SECTION 10 Condition of Enrolment
1. Student Visa
Students must have a valid visa with permission to study in AGI from INZ before their programme commencement
date. Students can only undertake employment according to the visa condition issued by Immigration New Zealand.
Full details of visa and permit requirements, advice on rights to employment in New Zealand while studying, and
reporting requirements are available through the New Zealand Immigration Service, and can be viewed at
https://www.immigration.govt.nz/
2. Fees
All fees including material fee and registration fees are to be paid in New Zealand dollars to:
Public Trust AGI EDUCATION LIMITED, Bank of New Zealand, North End Branch, Wellington,
Account NO.: 02-0536-0305865-01.
All fees paid are held in the Public Trust account and disbursed as per the public trust rules as per NZQA guidelines.
Version: 6 Date: September 2016
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07-B11-01
AGI may charge a fee for e-learning costs, materials and a registration fee separately. The total costs and other
financial commitments associated with the programme or training scheme, and the fees charged for student services
provided by AGI are listed on the Invoice provided.
Fees must be paid in full, in advance, for the period of study stated on the Application Form. All fees are calculated
in complete weeks and any part of a week is counted as a full week. No compensation is given for Public Holidays
when the school is closed.
AGI may offer scholarships to different students from different markets from time to time. AGI reserves the right to
explain, change or cancel the scholarship if necessary without public notice.
3. Accommodation
AGI uses accommodation agents to organise and monitor student accommodation following the Part 6 to the Code
of Practice for the Pastoral Care of International Students.
4. No Parking Facility at AGI
Students are required to use public transport to commute to and from AGI as parking facility is NOT available in
and around AGI campuses.
5. Learner Withdrawal and Refund Policy
Please refer to the Programme Learner Handbook.
6. Insurance
International students must hold acceptable Medical and Travel insurance from the time of their enrolment until their
visa expiry date (or departure from New Zealand). Immigration New Zealand has defined “acceptable insurance” as
insurance that is compliant with the Code of Practice and acceptable to the student’s education provider.
7. Pastoral care, welfare and student support services
Please refer to the Programme Learner Handbook.
8. Disciplinary procedures
Please refer to the Programme Learner Handbook.
9. Assessment Policy
Please refer to the Programme Learner Handbook.
10. Recognition of prior learning or current competency
Please refer to the Programme Learner Handbook.
11. Holidays during courses
A maximum of 2 weeks’ holiday without loss of tuition fees may be taken for each 24 weeks of study. No refunds or
extension will be granted in excess of this allowance. At least 1 weeks’ notice of a request for a holiday must be
given. If not, holiday credit may not be given and tuition fees will be lost.
12. Attendance and behaviour
The student is expected to attend all classes punctually and must comply with the conditions of his/her visa to stay
in New Zealand. Immigration New Zealand expects students to maintain full attendance.
The student must behave considerately both at the school and outside and must obey the laws of New Zealand. The
student must obey the school rules and AGI may take disciplinary action, according to its disciplinary procedures,
such action, if it is a serious breach of AGI rules, may include suspension and/or withdrawal of enrolment without
refund.
Version: 6 Date: September 2016
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07-B11-01
13. Liability
The student must hold adequate medical and travel insurance throughout his/her period of enrolment and any
extensions. AGI cannot be held responsible for any sickness, injury, death, damage or loss incurred either outside of
the AGI campus or within the AGI campus, clinical placement, or on AGI activities / tours outside campus.
AGI shall not be liable if the services offered cannot be provided for reasons beyond AGI’s control.
14. Complaint procedures and grievance procedures
Please refer to the Programme Learner Handbook.
15. Parental consent for students under the age of eighteen (18) years
Student below the age of 18 require the consent of his/her parents or guardian/s before enrolling at the school. A
parent or legal guardian must sign the Application Form if the student is under 18 years of age. These terms and
conditions shall bind the parent or legal guardian. If the student is aged 18 years or older then the duties, obligations
and authorizations of the parents of the student as set in these terms and conditions shall attach to the student, and all
references to ‘parents’ shall be read accordingly.
Student Welfare Officer will provide ongoing pastoral care service during enrolment. The parents and/or the legal
guardians must ensure they have read and understood the pre-application information before signing the application
form. The parents or legal guardian/s for students, who are under the age of 18 must read the Education Code of
Practice for international students on the link http://www.nzqa.govt.nz/assets/Providers-and-partners/Code-ofPractice/school-guidelines-code-of-practice.pdf
16. Programmes
Please refer the AGI Learner Handbook for programme descriptions and the entry requirements. Evidence of English
Proficiency needs to be provided with previous academic records as per entry requirements. Should the application
be successful; the student will be offered a place. The student must sign and return the Offer Letter to accept the
Offer of Place and pay the all fees before a Visa is granted. Due to insufficient student enrolments, staff resource and
/ or other matters, AGI reserves the right to explain, change or cancel the course and fees without public notice. When
in event of insufficient number of enrolments, AGI has the ability at any time to move students to other accredited
programme providers.
17. Validity
These conditions are valid at the time of signing this agreement and will remain in force until they are replaced by a
subsequent set. Where these conditions are translated into another language, the English language version will be
deemed to be the basis of this contract.
SECTION 12 Student Declaration (All Students must read the following information and sign)
a.
I and my parents and /or legal guardians agree to abide by the statutes, regulations and policies of the AGI.
b.
I and my parents and /or legal guardians have read and understood the pre-application information in this
application.
c.
I myself or my agent has taken me, my parents and /or legal guardians through the pre application information
in my own language.
d.
I declare that the information I have supplied on this form and any attached documentation to be true and
complete and that I have personally completed the form and am the sole author of the student statement and
resume. I have not withheld information which could have a bearing on my enrolment or the conditions of my
enrolment. I acknowledge that AGI may suspend or terminate my enrolment if false information has been
supplied or required information is not supplied by the due date. AGI reserves the right to inform all other New
Version: 6 Date: September 2016
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07-B11-01
Zealand Institutes, Immigration New Zealand, and the Police, of such cases, include the student’s name and date
of birth.
e.
I understand that all documents submitted with this application become the property of AGI and will not be
returned to applicants. I agree to supply further documentation requested by AGI for the purpose of my
enrolment.
f.
I understand that AGI will collect, store, use and disclose personal information about me in the course of
conducting its proper business and that a unique identifier will be assigned to me to facilitate this. I have read
and understand how such information will be managed and disclosed in accordance with the Privacy Act 1993.
I acknowledge that I have the right to access and seek correction of personal information about me and
understand that if I withhold information or provide false or misleading information my enrolment may be
terminated.
g.
I authorise AGI to release information regarding my application to Immigration New Zealand and the
Department of Labour where AGI considers the information relevant to my immigration status.
h.
I authorise any agency holding the source of any information I have provided on this form to release that
information to AGI upon request.
i.
I have read and understood all AGI policies and procedures in the Programme Learner Handbook.
I am aware of the tuition and living costs associated with studying in the programme and I am able and willing
to meet all expenses for the duration of my study. I understand that if I am unable to meet the costs, AGI and
New Zealand Government will not be expected to help me.
k. I understand that AGI may contact me via email, text messages, phone or by post for communications regarding
my enrolment, or student services at AGI.
j.
l.
I have
 completed all sections in this form
 enclosed certified copies of the official academic transcripts including graduating certificates and
explanation of the grading system and an English translation (if applicable)
 enclosed certified copy of the current passport or birth certificate
 enclosed certified copy pf evidence of English proficiency test results
 enclosed certified copies of other supporting documentation related to this application
 read and understood the pre application information
 read and understood Programme details and the policies as per the Programme Learner Handbook
 read and understood the New Zealand Privacy Act 1993
 read and understood the declarations and signed and dated this application form
Should the application be successful; the student will be offered a place. The student must sign and return the Offer
of Place to AGI.
Applicant Signature: ______________________________
Applicant Name: _________________________________ Date _______________________________________
If you are under 18 years old, you must sign this form in the presence of your parents or Legal Guardians.
Parent / Legal Guardian Signature: __________________
Parent / Legal Guardian Name ___ Date _______________________________________
If you have any questions about your application, please call us on +64 9 3796628 or email info@agi.ac.nz and we
will be happy to assist you.
Version: 6 Date: September 2016
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